Workers' Comp Frequently Asked Questions
- You must report your injury to your employer within 30 days from the date of the injury, or from the date you knew your injury or illness was related to your job. If you do not notify your employer within these 30 days, your right to obtain benefits could be lost.
- You must send a completed Employee's Claim for Compensation for a Work-Related Injury or Occupational Disease (DWC Form-041) to the Texas Department of Insurance, Division of Workers' Compensation (TDI-DWC) within one (1) year of the date of injury to protect your rights.
- For more information please see the Injured Worker Rights and Responsibilities or call Customer Assistance at 1-800-252-7031
Death benefits may be paid for legal beneficiaries of a person who dies as a result of a work-related injury or occupational illness. If the deceased’s employer carries workers’ compensation insurance, a spouse, children, grandchildren, other dependents or parents could be eligible for death benefits. A person who incurred liability for the costs of burial may also be eligible for payment of up to $6000.00 for burial expenses if the death results from a compensable injury. For answers to your questions about whether you may be an eligible beneficiary and whether you may be entitled to death benefits, see the Death Benefits webpage, or contact Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) Customer Assistance at 1-800-252-7031.
The Texas Department of Insurance, Division of Workers' Compensation staff is available to answer questions regarding your claim. For more information, please call Customer Assistance at 1-800-252-7031 or you may find your local field office information by clicking on DWC Offices by County and locating your county name.
Read more about your right to receive information and assistance with your claim.
Medical benefits pay for the medical care necessary to treat a work-related injury or illness. If you were injured on-the-job, you may be eligible to receive medical benefits. For more information please click on Medical Benefits or call Customer Assistance at 1-800-252-7031.
If your employer provides workers’ compensation medical care through a certified workers’ compensation health care network, you must select a treating doctor from the network’s approved provider list. The insurance company is required to provide your employer with a contact list of participating treating doctors. Ask your employer for the list so that you can select a treating doctor. The treating doctor will supervise your treatment and be your liaison with any other providers in the network. If your employer does not provide care through a network, there are several ways to find a doctor to treat your injury or illness:
- Talk to your primary care provider and ask if they treat workers’ compensation patients. Your family doctor may be able to treat you. If not, ask your doctor to help you find a doctor to treat your injury. Ask your doctors’ office staff, then family and friends about doctors who treat workers’ compensation patients.
- Use your local telephone directory. Many doctors list workers’ compensation services in their advertisements. Not all doctors treat workers’ compensation injuries. When calling a doctor for an appointment, ask whether the doctor accepts workers’ compensation patients and be sure to ask if the doctor is accepting new workers’ compensation patients.
- Additional Information
- Only doctors licensed to practice in Texas may treat workers’ compensation injuries and illnesses.
- If you are receiving care in another state, the doctor must be licensed in that state.
- A list of some doctors who may be willing to treat a workers’ compensation injury can be found here (Select the Locate Doctor option from the Main Menu option, choose the type of doctor and/or the geographic location in which you need a doctor, and view the selected individual's information.)
It depends. Qualifying for wage replacement benefits (Temporary Income Benefits, or TIBs) is determined on a case-by-case basis. TIBs replace a portion of wages a worker loses because of a work-related injury or illness. If you are eligible to receive these benefits, you will be paid by your employer's workers' compensation insurance company. Please note that your eligibility is dependent on your ability or inability to return to your job.
You don't have to be completely recovered to go back to work - in fact, you might be able to return to work while you are still healing. To do this, you should:
- Talk to your doctor. Tell him about your regular job and other jobs in the company. This will help him to determine what type of work you can do safely.
- Talk to your employer. Let them know you want to come back to work. When your doctor says it is safe to return to work, let your employer know so that they can try to find work within your restrictions, if any.
Call your adjuster to discuss your claim. Very often, speaking with the adjuster can clear up your concerns quickly and easily.
However, if that does not resolve the problem, you should contact Customer Assistance at 1-800-252-7031 to see if you should request a Benefit Review Conference. At that point, Division staff can help you try to resolve your dispute. If they are unable to resolve it you may need to attend a Benefit Review Conference (and possibly additional dispute resolution proceedings.)
You are not required to have assistance from an attorney, however you do have the right to obtain the services of one at any time. The attorney may attend dispute resolution proceedings with you and may present your evidence and your side of the dispute.
Read more about the right to hire an attorney.
An Ombudsman is a specially trained employee of the Office of Injured Employee Counsel (OIEC) who can assist you if you have a dispute with your employer's insurance carrier free of charge. For more information on Ombudsman assistance see http://www.oiec.state.tx.us/topics/ombudsman.html.
General information questions (not related to a proceeding) should be directed to Customer Assistance at 1-800-252-7031 or see the Resolving Workers' Compensation Claim Disputes page.
You are required to attend a designated doctor examination. A designated doctor is a doctor selected by TDI-DWC to make an recommendation about your medical condition or to resolve a dispute about a work-related injury or illness.
The designated doctor will:
- review medical information from your treating doctor and other doctors who have treated you for your work-related injury or illness;
- examine, test, and evaluate the parts of your body affected by the work-related injury or illness;
- determine if you have reached maximum medical improvement and, if so, when;
- give you an impairment rating if you have reached maximum medical improvement. If you have not reached maximum medical improvement, the designated doctor cannot give you an impairment rating; and
- submit a medical evaluation report, including a narrative report and documentation of your impairment rating, to TDI-DWC within seven (7) days of the date you were examined. The designated doctor also must send a copy of the report to you and the insurance carrier.
For more information please call Customer Assistance at 1-800-252-7031.
If you believe your work environment is unsafe, please contact the Safety Violations Hotline at 1-800-452-9595 or you may send your information via e-mail. Reports are taken in both English and Spanish and can be made anonymously.
For more information regarding the Safety Violations Hotline or how to e-mail your report, click on the following link: Safety Violations Hotline
Your claim file information is confidential and only those parties dealing with your claim have the right to obtain that information. For more information, please call Customer Assistance at 1-800-252-7031.
Read more about your right to confidentiality.
There are agencies within your own community that may be able to provide you with assistance while your claim is being resolved. For instance, some agencies provide assistance with utility bills. Each county or city has its own set of services. To learn more about services in your area, please call Customer Assistance at 1-800-252-7031.
A Letter of Clarification (LOC) is a letter drafted by the Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) and sent to a designated doctor requesting clarification on certain issues in a report the designated doctor submitted following the examination of an injured employee.
Under 28 Texas Administrative Code (TAC) §127.20 parties to a workers’ compensation claim who want clarification of a report of a designated doctor may file a request with the TDI-DWC for a LOC. Parties may only request clarification on issues § addressed by the designated doctor’s report or on issues that the designated doctor was ordered to address, but did not address.
The TDI-DWC may contact the designated doctor requesting a LOC, “if it determines that clarification is necessary to resolve an issue” regarding the report [28 TAC §127.20(a)].
Under 28 TAC §127.10(j), disputes regarding entitlement to benefits affected by a designated doctor’s report shall be resolved through the dispute resolution process.
Yes, the TDI-DWC can provide you a copy of the workers’ compensation claim file we maintain. To request a copy, complete and submit a DWC Form-153, Request for Copies of Confidential Claimant Information. The form can be downloaded from http://www.tdi.state.tx.us/forms/form20other.html or you can call 1-800-252-7031 to request that a blank form be mailed to you.
You must mail the completed form to the TDI-DWC. Faxed or e-mailed submissions of the DWC Form-153 are not accepted. Complete the form in its entirety and have it notarized before submitting to the TDI-DWC. If you have multiple workers’ compensation claims, submit a separate DWC Form-153 for each workers’ compensation claim you are requesting.
There may be charges associated with requesting your claim file. If your claim file is more than 100 pages, you will be charged a copying fee of 10 cents for all pages over 100. You may request to have your workers’ compensation claim file certified by TDI-DWC for an additional $1 charge.
-Cited from TDI.TEXAS.GOV.